Provider Demographics
NPI:1417101098
Name:BERRY, LAUREN MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:UNFLAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH LANGUAGE PATH
Mailing Address - Street 1:62 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:585-739-1325
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:402-452-5000
Practice Address - Fax:402-452-5028
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76766SP-SL235Z00000X
NE1288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist